Provider Demographics
NPI:1043217326
Name:HOLLINGSED, MICHAEL JAMES (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:HOLLINGSED
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:STE 212
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5008
Mailing Address - Country:US
Mailing Address - Phone:915-532-3977
Mailing Address - Fax:915-532-5866
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:STE 212
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5008
Practice Address - Country:US
Practice Address - Phone:915-532-3977
Practice Address - Fax:915-532-5866
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01519363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3172736Medicaid
TX8B1828Medicare ID - Type Unspecified
TX3172736Medicaid